So... the standards recommend that continuous therapy be sought throughout the lifetime of the transsexual. At least some doctors will discontinue HRT if you are not continually seeing a therapist. It seems to me that we are pretty much chained to somebody that should sort out our lives for the rest of our life.

I think I have a problem with this. Now, I realize that therapy is very suitable for some throughout their lifetime. I also realize that it may be important to initially undergo therapy to ensure that the path you want is not dangerous to your psychological well being. However, there are points in life that, while quicker to come by in some than others, that therapy just becomes a drag rather than help.

For example, my last endocrinologist recommended that I see a therapist throughout her treatment, even after transitioning. On the second appointment post-transition, we ended the session half an hour early because we simply had nothing left to talk about. $20 down the drain because even the therapist saw no reason for me to be there. He was probably thinking "Why is she wasting my time with this... I could be helping dope addicts and domestic violence cases instead of her. She is perfectly fine!"

Thing is, nobody wants to do SRS on you either without a therapists approval. I can understand this... but does that mean I seriously need to visit a therapist regularly for pretty much no reason other than to get a sign off on a sex change operation? Honestly, if I have to - I may be flat out blunt with the next therapist I hire and say "I'm only here to get an approval letter for SRS." shortly before I plan to get SRS. I do not see anything helpful with me paying money every couple weeks / couple months for something that benefits me in no real tangible way!

Am I in the minority who sees this as silly? Has anybody been successful at just straight up going to a therapist for maybe 1 or 2 sessions (after being able to prove transition with say, a photo ID that is 2 years old or greater) and asking for an SRS letter? In my case - not one person has ever questioned whether I should be a boy or girl after I went full time. I know I'm not the only one in the world with these thoughts.

I completely have the same thought process. My psych did say I no longer need to see her. I told her I need to see her until I can get SRS. She said that I can just come in every 4-5 months, and if I need anything before then just to call her. She knows that I am just using her to get my letter, and she does not care. I find it rediculous that just because someone is trans that they "must" have a psychological condition that requires lifetime therapy.

Luckily, I get my care throught the VA, so none of my appointments cost anything. And, there is no requirement that I must see a psych to stay on hrt. They just need one visit to a psych who agrees I have it in order for me to get it.

Quote from: Brooke777 on October 24, 2012, 01:49:26 PM
I find it rediculous that just because someone is trans that they "must" have a psychological condition that requires lifetime therapy.

Right??! My psychological trauma came from living as a boy for so freaking long. I'm cured

Q: When does therapy become unneccessary?
A: When you are finally happy with who you are

Quote from: Alainaluvsu on October 24, 2012, 02:05:00 PM
Right??! My psychological trauma came from living as a boy for so freaking long. I'm cured

Well then, ask the therapist to justify their own existence. Ask them what is wrong with you that justifies continuing therapy. They either have to

a) Give you a list that you can work through, or

b) Admit that your visits are pointless.

It should be interesting either way....

I finished therapy about 10 months after I started - mainly it was for my wife and I -- she helped us through my transition.

She said she didn't see any reason to continue and gave me the letters I needed for surgery.  Told me to contact her if the doctor needed a more current one and that she would update it.

Quote from: Jayne on October 24, 2012, 02:25:00 PM
Q: When does therapy become unneccessary?
A: When you are finally happy with who you are

I've been happy for months. But it seems to me that doctors can pretty much force your hand to go, which is an unnecessary financial expenses. My money is funny!

From the WPATH standards of care (http://www.wpath.org/documents/SOC%20V7%2003-17-12.pdf) page 28:

Quote1.  Psychotherapy is not an absolute requirement for hormone therapy and surgery

A mental health screening and/or assessment as outlined above is needed for referral to hormonal and surgical treatments for gender dysphoria. In contrast, psychotherapy – although highly recommended – is not a requirement.

Note the bold face is their emphasis, not mine.

Later, page 31:

QuoteMental health professionals may work with clients and their families at many stages of their lives. Psychotherapy may be helpful at different times and for various issues throughout the life cycle.

Note there is no requirement there.

The SOC seem fairly progressive on this. It maybe what we're blaming on the SOC comes instead from individual practitioners and institutions stuck in the Harry Benjamin days.

Quote from: agfrommd on October 24, 2012, 06:55:33 PM
It maybe what we're blaming on the SOC comes instead from individual practitioners and institutions stuck in the Harry Benjamin days.

That's who I'm really looking at with this post... are the HRT doctors and the surgeons.

Quote from: Alainaluvsu on October 24, 2012, 01:17:22 PM
So... the standards recommend that continuous therapy be sought throughout the lifetime of the transsexual. At least some doctors will discontinue HRT if you are not continually seeing a therapist. It seems to me that we are pretty much chained to somebody that should sort out our lives for the rest of our life.

I think I have a problem with this. Now, I realize that therapy is very suitable for some throughout their lifetime. I also realize that it may be important to initially undergo therapy to ensure that the path you want is not dangerous to your psychological well being. However, there are points in life that, while quicker to come by in some than others, that therapy just becomes a drag rather than help.

For example, my last endocrinologist recommended that I see a therapist throughout her treatment, even after transitioning.

Completely ridiculous. Why is everything such a game with this whole thing. I really resent the whole game. I am going to a counselor who doesn't play this game, and it sounds like perhaps your's doesn't either. Perhaps you can maintain a VERY informal relationship-- call me if you have an issue type thing, sort of like Brooks talks about.
I don't think that's too great, but be a way of solving this silly issue.


--Jay J

as far as you are consider, when you are happy with yourself and pretty sure about your choice.

as far as the "gate keepers," when they are convinced you are a "true GID," and that you do not have other underlying psychiatric problems

Quote from: Alainaluvsu on October 24, 2012, 01:17:22 PM
So... the standards recommend that continuous therapy be sought throughout the lifetime of the transsexual. At least some doctors will discontinue HRT if you are not continually seeing a therapist. It seems to me that we are pretty much chained to somebody that should sort out our lives for the rest of our life.

I think I have a problem with this. Now, I realize that therapy is very suitable for some throughout their lifetime. I also realize that it may be important to initially undergo therapy to ensure that the path you want is not dangerous to your psychological well being. However, there are points in life that, while quicker to come by in some than others, that therapy just becomes a drag rather than help.

For example, my last endocrinologist recommended that I see a therapist throughout her treatment, even after transitioning. On the second appointment post-transition, we ended the session half an hour early because we simply had nothing left to talk about. $20 down the drain because even the therapist saw no reason for me to be there. He was probably thinking "Why is she wasting my time with this... I could be helping dope addicts and domestic violence cases instead of her. She is perfectly fine!"

Thing is, nobody wants to do SRS on you either without a therapists approval. I can understand this... but does that mean I seriously need to visit a therapist regularly for pretty much no reason other than to get a sign off on a sex change operation? Honestly, if I have to - I may be flat out blunt with the next therapist I hire and say "I'm only here to get an approval letter for SRS." shortly before I plan to get SRS. I do not see anything helpful with me paying money every couple weeks / couple months for something that benefits me in no real tangible way!

Am I in the minority who sees this as silly? Has anybody been successful at just straight up going to a therapist for maybe 1 or 2 sessions (after being able to prove transition with say, a photo ID that is 2 years old or greater) and asking for an SRS letter? In my case - not one person has ever questioned whether I should be a boy or girl after I went full time. I know I'm not the only one in the world with these thoughts.

What  , my therapy was limited to a couple of hours in an afternoon.

You know when they ask you about your sexual orientation? my answer is: we do not need to talk about that, I never been confused or trouble by it.

For me, therapy was a total waste of my time. I had to get an HRT letter even though I had already been living full time for 3 years and was very happy. I had no issues at all. I ended up going for 3 months before she would give me a letter and at the sessions I would talk about like how I like to ride bicycles etc. When I said after a few visits "This feels like I have to get your permission to start HRT, she said it was my resenting the control my dead mother has over my life or some nonsense. (rolls eyes). It was absurd.

I can understand some people really need therapy but just because someone is TG doesn't instantly mean they need therapy. The doc I see doesn't see any reason whatsoever for me to continue this. But like you said, if I decided I want SRS or even an orchie, I know I am going to HAVE to get more therapy I don't need. I see people bitch about having to go through RLE first, what about the people like me who are already living successfully as women for years and are happy? At what point do I not have to PROVE I'm not crazy for wanting to be a woman?

Exactly Stephe!

I love my last endo to death but the choices of doctors to go to for HRT in the last place I lived was very limited. She basically insisted that I go through therapy even though I was self medicating before seeing her. She even checked in with my therapist to make sure I was going! I mean... seriously? Not to sound arrogant... but I'm done with that point in my life. Can I save my $40 an hour for a cute outfit or some concealer ... or RENT? How the hell do they expect us to live a normal life as a female if we have to be psycho analyzed til we get a sex change... or die depending on the doctor / place you live.

I mean it's hard enough to get a job for many of us, let alone pay bills while buying a whole new wardrobe, saving for surgeries, laser, electro,hormones, lab tests, doctors visits, name changes... but I have pay a therapist that I almost wanted to ask "... so! Who Dat!!" because there was nothing else to talk about. Silly doctors!

My wife was pre-op for about 10 years before her surgery. For the most part she only saw her therapist maybe once a year or two or three after the early stages of transition. No problems with the endo. One woman in my group sees her endo once a year w/no hassle about having to see a therapist.

Perhaps this is because in both cases we're talking big cities, NYC and San Diego? For most that are well grounded and feeling that there is no need other than maintaining some sort of a relationship untill SRS time if an endo demands a yearly letter, all it may take is a phone call to ask for a new one. Worse case it costs you an appointment. Doesn't hurt to ask.

Now, if you have a control freak for a therapist.... Get a new one? The same applies for the endo. Big problem I am seeing out here in the hicks is just finding ANY that will treat a TS is rare. Not a big city problem at all

When does therapy become unneccessary?
1. When you have the letter(s) you need and that's all you need; OR
2. If you need more, when your relationship is no longer therapeutic, just friends catching up on the victories of your life.

I am grateful for my therapist, but I totally understand those whose only trauma was living in the wrong gender and who once transitioned only need a therapist to write those letters.

Sad to say but it boils down to the other providers.  The big problem with modern healthcare is that too much litigation happens these days.
Endos and SRS surgeons are covering themselves.  Example scenario:
A person who seems to be MTF presents to an endo, dressed well, asks for HRT, endo thinks this person is genuine GID, prescribes the hormones.
This person then goes for SRS, then regrets the whole deal, and then sues them.  Armchair Dr (lawyer) points out that person hasn't been checked/diagnosed, wins lawsuit and profits.

Now, what I said doesn't happen that often.  But it does, and as a result, the expected duty of care from a health provider has risen and referral rates, and orders for diagnostics have sky-rocketed as a result.  So unfortunately, even if the endo or SRS surgeon is sure of your decision, they're basically required to make you get a recommend letter from a medical indemnity insurance point of view.

As far as when actual _helpful_ therapy becomes unnecessary?

My feeling on it is when you're comfortable in your own skin.  I had my last therapy session over 9 years ago, and only started HRT this year.  My GP and endo were happy to start me on low dose as I was quite specific about what I was aiming to achieve.  Further therapy for me will basically only retread the same topics over and is likely to be unproductive at this point in time.

I've had no therapy sessions and I'm hoping I don't have to, any other than the one I need for my grs letter. I have an inbuilt distrust of therapists. I'm not sure why but I get the feeling they're actually just taking the p**s. There isn't any evidence to show one type of therapy is more "effective" than any other (effective at what??) basically all that's known is "talk therapy" helps some people some of the time.... Hmmm so does homeopathy... I'm a fan of evidence based medicine. If there isn't any evidence to suggest one type of therapy is more "effective" than another then it follows we shouldn't take these people's "diagnoses" very seriously. What was their diagnostic tool? Is it repeatable? Is it testable? Are their theories falsifiable? Untill I see good evidence based arguments for one type of therapy over another, I'll continue to call shinanagins on therapy for GID. The evidence suggests a nuerobiological basis of transsexualism much much more than a psychological one. How many other nuerobiological (or congenital for that matter) conditions can you think of that require a "therapist" to talk to you before you're able to accsess medical treatment?
Before anyone jumps down my neck for saying that, yes I understand talk therapy has a lot of value in a lot of situations. I'm talking specifically about how I feel it relates to the medical condition known as transsexualism, nothing more.
If someone develops or is born with diabetes, cancer or any other condition, talk therapy can probably be very helpful in resolving feelings or whatever but, it's not a requirement for insulin or chemo therapy. That would be putting the wagon before the horse.

Quote from: Isabelle on October 25, 2012, 06:54:43 AM
There isn't any evidence to show one type of therapy is more "effective" than any other (effective at what??) basically all that's known is "talk therapy" helps some people some of the time

Well, there might be. After one of the big disasters (I think it was the Lockerbie disaster) they did a follow up on trauma counselling and, IIRC, the results were these

For 25%, counselling helped
For 50%, counselling made little difference
For 25%, counselling made things worse

So, on average......

[Note for pedants and other strange types: I know there is a difference between gender therapy and trauma therapy, but these are the only stat.s I could remember. The best I can do in the heat  of the moment ]

Wow... 75% nothing or worse.. Trauma isn't really relavent to the discussion though I don't think.. Maybe it is to some people but I don't think that's enough of a reason to universalise "everyone's" experiences.
Also... Is the forum being weird? Random People's avatar photos are popping up in people's posts? Maybe it's just my phone being weird..